Access to Neuropsychologic Services After Pediatric Brain Tumor.

Background: Increasing survival rates for pediatric brain tumor patients creates a greater need for neuropsychologic follow-up and intervention. The aim of this study was to evaluate rates of referral by medical doctors to neuropsychologic services and patient and treatment factors that differentiated referred and non-referred patients. Methods: Data were retrieved from medical records of all pediatric brain tumor patients in Southern Sweden diagnosed between 1993 and 2004 who survived more than one year (n=132). Characteristics of the patients, the cancer, and treatment received were then compared for patients who were and were not referred for neuropsychologic examination during that period. Results: Sixty-four (48%) of the pediatric brain tumor patients were referred for neuropsychologic evaluation. These patients had significantly larger tumors, more recurrences of cancer, and increased intracranial pressure at diagnosis when compared to the non-referred group (n=68). However most of the patients in the non-referred group either had risk significant factors for cognitive impairment or were reporting impairments that would suggest a referral was warranted. Conclusions: Given the high rates of cognitive impairment found in patients with pediatric brain tumors, survivors should be referred to neuropsychologic services. In addition to improving long-term adjustment, systematic referral can provide data on cognitive impairments that may inform cost-benefit-analyses when deciding on various treatments at the point of diagnosis. Greater efforts are needed to disseminate and raise awareness about published guidelines on the long-term care of pediatric brain tumor patients